Spinal Injury Flashcards

1
Q

What are the three care objectives in SCI?

A
  1. Identify SCI and transfer to appropriate facility
  2. Protect and support spinal column integrity where SCI/unstable vertebral injury unable to be excluded
  3. Avoid unnecessary immobilization by excluding pts without spinal injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the intent behind spinal immobilisation?

A

The intent of spinal immobilisation is to support the neutral alignment of the spinal column and reduce or distribute forces placed on it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For what reasons might a collar not achieve the desired support, and what can be done about this?

A

Pt’s anatomy doesn’t permit, pt agitated.

Can be adjusted, loosened or removed if no other options.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the optimal position for spinal immobilisation? Which patients might this not be possible and how should it be managed?

A

Supine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which patients might it not be possible to place supine for spinal immobilisation and how should it be addressed?

A

May not be possible due to pain, vertebral disease, kyphosis, injuries prevent the position, CCF.
Support the pt in a POC.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Can patients be transported on a CombiCarrier board after extrication?

A

No, pts must be removed from board for transport.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What note is made about restraining the head for spinal immobilisation?

A

The head must not be independently restrained to the stretcher.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the 4 “Concerning” potential mechanisms of movement for a ?spinal pt.

A
  1. Hyperflexion
  2. Hyperextension
  3. Hyperrotation
  4. Axial loading of the spinal column
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 4 MOI’s that should infer concern for damage to a healthy vertebrae?

A
  1. Car rollover
  2. Car ejection
  3. Pedestrian impact
  4. Diving accident
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

After trauma of any kind, which patients should be treated with a high index of suspicion for unstable cervical spine injuries?

A
  1. Older pts
  2. Pts with a Hx of vertebral disease/spinal abnormality eg.
    a. ankylosing spondylitis
    b. spinal stenosis
    c. spinal fusion
    d. previous c-spine injury
    e. rheumatoid arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pts with penetrating trauma should…?

A

Not be routinely immobilised. Consider immobilisation only were demonstrable neurological deficit.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

An altered conscious state under the Spinal Injury guideline includes…?

A

Any presentation that may confound the results of a physical examination e.g GCS <15 for any reason, concussion, dementia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be considered for prophylaxis in spinally immobilised pts?

A

Antiemetics, for all awake, immobilised pts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What immediate indications require a pt to be spinally immobilised?

A

MOI/traumatic injury with potential for SCI
+
Meets MTC after blunt force trauma to head/trunk
OR
Neurological deficit/changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Under the Spinal Injury guideline, what are the 4 elements and 7 subsets for the modified Nexus criteria?

A
  1. Increased Injury Risk
    - Age ≥65
    - Hx bone/muscle weakening disease/injury
  2. Difficult Pt Assessment
    - Altered conscious state
    - Intoxication
    - Significant distracting injury
  3. Actual Evidence of Structural Injury
    - Midline pain on palpation of vertebrae
  4. Neck Range of Motion
    - Pt is unable to actively rotate neck 45º left/right without pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is a pt spinally cleared?

A

None of the modified NEXUS criteria are present.

17
Q

If a pt is immediately indicated for immobilisation (neuro deficit or meets MTC), what is the management?

A
  1. Apply cervical collar
  2. Extricate with combi if necessary
  3. Immobilised on vacuum mattress/stretcher
  4. Tx without delay (time critical)
  5. Consider antiemetics
18
Q

In conjunction with standard process for pts immediately requiring immobilisation, what additional managements should be enacted in the presence of an isolated SCI?

A

If BP <90mmHg, Normal Saline 10ml/kg IV

19
Q

If the pt does not meet the criteria for immediate immobilisation, but is unable to be cleared via the modified NEXUS, what is the management?

A
  1. Apply cervical collar
  2. Extricate on combi if necessary
  3. Consider self extrication where the pt is conscious/cooperative, not intoxicated and not prevented from doing so by injury
  4. Immobilise to vacuum mattress or stretcher
  5. Consider antiemetics
20
Q

In what circumstances is self-extrication appropriate in the pt requiring spinal immobilisation due to presence of NEXUS elements?

A
  1. Conscious and cooperative
  2. Not intoxicated
  3. Not prevented from doing so by injury
21
Q

How should neurological function be examined for the NEXUS criteria?

A
  1. Motor Function (assess for any weakness)
    Arms - push, pull, grasp
    Legs - plantar flex (push), dorsiflex (pull), leg raise
  2. Sensory Function (assess for altered sens.)
    Arms - light touch to palms/ back of hand
    Legs - touch lateral aspect of calcaneus
    (side of heel)
    Suprasternal notch - light touch
  3. Any other numbness, tingling, burning, altered sensation.
22
Q

If any neurological alterations per the NEXUS exam present then…?

A

Pt can not be spinally cleared.

23
Q

Should left and right sides be assessed for deficit separately or simultaneously?

A

Simultaneously.

24
Q

If weakness or inability to perform the test due to pre-existing condition then…?

A

Assess against the pts normal, baseline function.